One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial.

Serruys, Patrick W; Modolo, Rodrigo; Reardon, Michael; Miyazaki, Yosuke; Windecker, Stephan; Popma, Jeffrey; Chang, Yanping; Kleiman, Neal S; Lilly, Scott; Amrane, Hafid; Boonstra, Piet W; Kappetein, Arie Pieter; Onuma, Yoshinobu; Søndergaard, Lars; van Mieghem, Nicolas (2018). One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial. EuroIntervention, 14(8), pp. 877-883. Europa Digital & Publishing 10.4244/EIJ-D-18-00460

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AIMS The indication for transcatheter aortic valve implantation (TAVI) has evolved from inoperable patients to patients at increased surgical risk. In low-risk patients, surgical aortic valve replacement (SAVR) remains the standard of care. The aim of this study was to explore the outcomes of TAVI and SAVR in patients with a Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score below 3% in the SURTAVI trial. METHODS AND RESULTS In SURTAVI, patients at intermediate surgical risk based on Heart Team consensus were randomised to TAVI or SAVR. We stratified the overall patient population into quintiles based on the STS PROM score; the one-year mortality was correlated with the mean STS PROM score in each quintile. The quintiles were regrouped into three clinically relevant categories of STS score: less than 3%, 3 to <5%, and >5%. All-cause mortality or disabling stroke in each risk stratum was compared between TAVI and SAVR. Linear regressions between mean values of STS PROM in each quintile and observed all-cause mortality at one year showed great association for the global population (r2=0.92), TAVI (r2=0.89) and SAVR cohorts (r2=0.73). All-cause mortality or disabling stroke of TAVI vs. SAVR was 1.5% vs. 6.5% (p=0.04), 6.5% vs. 7.6% (p=0.52) and 13.5% vs. 11.0% (p=0.40) in the <3%, 3-5%, and ≥5% STS score strata, respectively. CONCLUSIONS Among patients at intermediate surgical risk but with an STS PROM <3%, TAVI may achieve superior clinical outcomes compared to SAVR. These findings support the need for an adequately powered randomised trial to compare TAVI with SAVR in patients at low operative risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

14 Mar 2019 11:04

Last Modified:

14 Mar 2019 11:04

Publisher DOI:

10.4244/EIJ-D-18-00460

PubMed ID:

29992904

URI:

https://boris.unibe.ch/id/eprint/125753

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